World AIDS Day 2009 - AfDB President Donald Kaberuka

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Event: World AIDS Day

Today we commemorate the World AIDS Day 2009 – the 21st such tribute since its launch by the World Health Organization in 1988. This year’s theme “Universal Access and Human Rights” is timely and pertinent. Next year is an important milestone for the Millennium Development Goals (MDGs) and there will be a high level review of progress made toward achieving the goals, including universal access to HIV prevention, treatment and care.

As you all know, universal access is a broad movement to develop and implement an essential package of HIV/AIDS, prevention, treatment, care and supportive services with the aim of reaching as many as possible of all those persons needing these services. It is recognized that while a broad, multi-sectoral response is required, the role of the health sector is central in these efforts.

The global theme is of particular importance to us on the African continent – the continent mostly deeply affected and hardest hit by HIV. The latest data on global HIV prevalence indicates that the epidemic has levelled off and that the number of new infections is decreasing, especially when compared to the mid-1990s. However, in 2008 in sub-Saharan Africa alone, an estimated 1.9 million people were newly infected with HIV, bringing the total number of people living with HIV in sub-Saharan Africa to 22.5 million.

While this is a significant reduction since 2001, it is nonetheless 68% of the global total. At the same time, 90% of the world’s HIV-infected children accounted for 76% of AIDS deaths in 2008. Eight countries in this continent account for almost 30% of all new HIV infections and AIDS deaths globally. The region’s epidemics vary significantly in scale with national adult HIV prevalence ranging from less than 2% in some countries to above 15% in most of Southern Africa.

You will agree with me that these statistics demand our attention and call us to action because more needs to be done in combating HIV/AIDS in our region. We know that this epidemic does NOT work in isolation. Poverty, deterioration of regional food security, economic and social instability are all intertwined with major infectious diseases including HIV.

The HIV/AIDS epidemic has curtailed our progress towards poverty alleviation in sub-Saharan Africa. HIV/AIDS has diminished economic growth in high prevalence countries and has made poor people even poorer. The epidemic has negated many of the health, social and economic gains of a generation in the worst-affected countries in Africa, including child survival and life expectancy. Countries with high HIV prevalence have experienced significant decreases in life expectancy between 1990 and 2006, ranging from eight to 25 years.

The main reason for such a significant decline is the increased mortality caused by AIDS among the productive age groups (women aged 20-29 years and men aged 25-34 years). The magnitude of the spread of HIV has also seriously affected the efforts to achieve the Millennium Development Goal (MDG) number 6, halting the spread of HIV by 2015 as well as the other major MDGs. Sustained progress on health-related MDGs will be impossible without adequate investments.

As you know, this is a domain of complementarity for us. We strongly support programmes and initiatives led by the UN specialized agencies and other partners in building systems. Despite all the efforts from governments, the international community including the Bank, civil society organizations, private sector and affected communities, the HIV/AIDS situation still remains serious. We must redouble our efforts and support countries to leverage existing resources from Global Fund to Fight AIDS TB and Malaria, and seek other sources to strengthen health systems if we are to make a major impact on the prevention and control of HIV/AIDS.

Now I will talk about HIV/AIDS in our AfDB community! The Bank’s medical officer has already highlighted the HIV/AIDS situation in the Bank, and also judging from the statements from guests we still have a long way to catch-up with the gains that have been made in the global community. For our workplace, more needs to be done and it is for this reason that I am very happy to be launching today the Presidential Directive for Comprehensive HIV/AIDS workplace. This is a significant step for us: our sincere corporate commitment in addressing HIV/AIDS challenges at our workplace and on our continent.

This directive is going to address a key challenge in our workplace, one of lack of motivation to know the HIV infection status among Bank staff due to fear of stigmatization and sense of hopelessness due to lack of corporate guidelines that clarify the rights of staff and options for prevention, treatment and care.

Three key areas will be the focus on our interventions in the directive, namely: the prevention of HIV infection through information and behaviour change communication; protection of the rights of those affected by HIV/AIDS; and the care for Bank staff and their dependents affected or infected by HIV/AIDS. I take this directive very seriously and I and senior management will follow up on it.

Managers and supervisors must take the lead in empowering themselves with HIV/AIDS knowledge so that we can lead by example. We need to know how to deal with staff with empathy and care.

Our behaviour needs to be consistent with appropriate national and international laws so all employees, regardless of their HIV status, can be treated with dignity.

Regular updates on HIV/AIDS knowledge must be imparted to all staff and families in order to encourage positive behaviour for healthier and safe lives.

HIV/AIDS silence must be broken at our workplace. Let us encourage open dialogue amongst ourselves.

We need to articulate more options for HIV/AIDS treatment and care for our community, both in Tunis (TRA) and in the field offices for which we are in the process of building appropriate in-house capacity. We are emphasizing the use of existing health systems in host countries and already discussions are ongoing to sign an agreement with the Tunisian Ministry of Health to create a team of HIV/AIDS specialists who will provide comprehensive HIV/AIDS testing, treatment and psychosocial care for the Bank community. I would like to assure you all that I have given instructions to management to ensure strict confidentiality and professionalism to all providers we will work with us.

Support active participation of persons living with HIV/AIDS and other partners. I would like us to reach a stage where we have people living openly with HIV/AIDS at AfDB without any fear, as do our colleagues in other organizations.

As you know, the state of health systems in many of our countries today is less than acceptable and is a major impediment to our development. The reality in most countries is that health systems are characterized by inadequate or currently over-used and dilapidated facilities; weak supply systems with frequent breakdowns in availability of essential drugs and limited numbers of well-trained and well paid health workers, particularly at the district level. A lot remains to be done! If we are to have optimal health systems that provide services to all those who need them and be able to scale up HIV prevention, care and treatment services, it is an essential determinant in the progress towards meeting the millennium development goals.

Recognizing the need to better support countries in the fight against HIV/AIDS, the Bank is managing its existing portfolio by providing selective support in coordination and complementarity with other partners. This means:

  • Supporting health systems and country capacity for service delivery within a broader health sector support;
  • Focusing support to mainstreaming HIV/AIDS activities in core priority non-health sectors – such as education, infrastructure, water and agriculture – whose activities have the greatest potential impact on the epidemic;
  • Supporting countries to build national planning capacities for RMCs in order to ensure integration of appropriate HIV/AIDS efforts into RMCs’ development agenda;
  • Assisting countries to better access and utilize resources from increasingly important vertical funds such as The Global Fund and philanthropic organizations such as the Melinda & Bill Gates Foundation; and
  • Forging effective partnerships with other development partners in support of countries.

This is a time of much possibility. We can turn Africa around. Remarkable progress is being made wherever political leadership supports the health sector through a multi-sectoral response. Where there is a strong coordination and wider community engagement we can be successful in combating HIV/AIDS. We have extraordinary challenges, but we also have extraordinary opportunities! Therefore, I call upon our countries to:

  • Demonstrate leadership and vision for the national ownership based on Universal Declaration Of Human Rights;
  • Forge strategic partnerships with all stakeholders;
  • Continue to allocate adequate resources in national budgets to the health sector in line with the commitments made in Abuja Declarations on HIV/AIDS, TB and other infectious diseases; and
  • Strengthen health systems to cope with the increasing needs of populations, including addressing the health workforce to meet these and other emerging health crises.

Together we can make a difference. Together we can build a generation without AIDS.

Thank you.